Maternity Survey 2019: Trust webinar 12 February 2019

1. Maternity Survey 2019: Trust webinar 12 February 2019

2. Agenda • Survey overview • What’s new for 2019? • Methodological changes • Questionnaire changes • Covering letter changes • Section 251 requirements • Practicalities of administration • Sampling and submission process • Fieldwork monitoring information • Key dates • Current status • Q&A

3. Survey Overview

4. Survey overview • Survey methodology largely unchanged from 2018. • Inclusion and exclusion criteria exactly the same as 2018. • Trusts will draw a sample of eligible women who had a live birth during February 2019 [and January 2019 for smaller trusts]. • We will also collect antenatal and postnatal attribution data to identify whether women are referring to your trust when answering the antenatal and postnatal sections of the questionnaire.

5. What’s new for 2019?

6. Methodological changes • Postcode data: • Subject to S251 approval, we have requested full postcodes for women who gave birth during the sample period • Additional sample variables: • Time of delivery; Number of babies born at delivery; Gender (allowing the coding of male, female and non-binary)

7. Methodological changes • Confirmation of contractor: • This year we won’t ask trusts to confirm their contractor to us. Instead we’ll ask contractors to send us a list of trusts they’re working with. • ICD-11 codes: • There are now 13 codes relating to stillbirths instead of 5. We will include both ICD-10 and ICD-11 codes for stillbirths in the exclusion criteria list in case some trusts are still using ICD-10. • Total deliveries vs exclusions: • Instead of total deliveries we will be asking for a list of exclusions. This will hopefully reduce confusion amongst trusts, and cut down on queries during sample checking.

8. Questionnaire changes • Significant redevelopment of the questionnaire: • In-depth interviews with stakeholders and qualitative research with recent mothers (babies less than 12 months old) • Desk research identifying developments in policy and models of maternity care service provision • Analysis of questionnaire performance using 2018 data • Recommendations of Survey Advisory Group • Cognitive testing with 22 women • Resulted in a number of changes: • 9 questions removed • 8 new questions added & LTC questions • Revisions to 80% of the remaining questions • Full details in Survey Development Report. • Questionnaire will be published after Ethics approval granted.

9. Questionnaire changes • 9 questions removed (2018): • A2, B5, B7, C2, D2, F6, F20, F21, G4 • 8 new questions & LTC questions: • B5: Before your baby was born, where did you plan to have your baby? • B12: During your pregnancy, were you offered any antenatal classes or courses offered by the NHS? • B13: Did you find these classes or courses useful? • C6: Where did you have your baby? • C7: Thinking about the birth of your baby, was your labour induced? • C22: After your baby was born, did you have the opportunity to ask questions about your labour and the birth? • F19: At the postnatal check-up (around 6- 8 weeks after the birth), did the GP spend enough time talking to you about your own physical health? • F20: At the postnatal check-up (around 6- 8 weeks after the birth), did the GP spend enough time talking to you about your own mental health?

10. Covering letter changes • Changes to format and wording in line with 2017 Mental Health pilot. • More information about data protection added. • Covering letters will be published after Ethics approval granted.

11. Section 251 requirements

12. What is Section 251? • Allows the common law duty of confidentiality to be put aside in order to enable the processing of patient identifiable information without consent. • Provides a legal basis for trusts to provide names and addresses to contractors. • Any deviation from the methodology outlined in the survey instruction manuals may render the approval invalid and CQC will be obliged to take action.

13. Section 251 requirements • Dissent posters give potential participants the opportunity to opt out of the survey: nhssurveys.org/surveys/1389 • With the exception of the trust information box, it is not permitted to alter the poster in any way. • In the box provided, a telephone number must be provided. In addition, an email and a postal address should be provided if they are available. • Posters must be on display during the sampling month(s) to comply with S251 requirements. • Young mothers leaflet (16-17 year olds): • Available on the NHS Surveys website here: nhssurveys.org/surveys/1390 • Accompanying briefing note to support use of the leaflet

14. Section 251 requirements • We recommend you publicise the survey both internally and externally to ensure women are aware of the survey and have the opportunity to opt-out should they wish. Example materials are available in the Publicising the survey document. • Ensure a log of women who have dissented from taking part in the survey is accurately kept. • Ensure the total number of eligible women who have dissented from the sharing of their details for any purpose other than their clinical care or who have dissented from taking part in the survey specifically are recorded in your sample declaration form and are excluded from your sample.

15. National Data Opt Out Programme - Exemption

16. Approval pending • Section 251 approval for the survey is still pending: • Approval granted ETA: Early March 2019 (TBC) • Sample data cannot be transferred outside of the trust until Section 251 approval has been granted.

17. Potential Section 251 breaches • Trusts sending sample data directly to the Survey Coordination Centre. • Survey Coordination Centre receiving mailing data. • Trusts submitting sample file via email rather than FTP. • Trusts mentioning patient identifiable information (e.g. DOB) over email. • Trusts not password-protecting files. • Generic document on Data protection and confidentiality available on our website.

18. Practicalities of administration

19. Practicalities of administration (in-house trusts only) • Questionnaire must be printed in colour, with centre staples. • Covering letters must also be printed in colour, on trust headed paper. • No faster first reminder. • No CQC flyer. • Questionnaire and covering letters to be published following Ethics approval. • PDF and hard copy covering letters and questionnaire to be submitted to us for checking and approval. • Detailed information on running the survey can be found on our website here.

20. Sampling and submission process

21. Instruction manuals • Three manuals for the Maternity Survey: • Survey handbook • Sampling instructions • Attribution instructions • Generic instructions can be found on the website.

22. Drawing the sample • Sample should include all eligible women aged 16+ who had a live birth in February 2019. • All eligible February births should be included – no maximum sample size. • If there are <300 eligible February births, trusts should sample backwards into January until they reach January 1st or until they reach 350 (then cap at 300 after exclusions and deceased checks). • Enter sample data into the Sample Construction Spreadsheet. • Please follow the instructions carefully and check all inclusion and exclusion criteria to prevent sampling errors. • Full details in Sampling Instructions.

23. Common sampling errors • Excluding home births. • Excluding women with a safeguarding flag without consulting safeguarding/midwifery team • Not including all eligible February births. • Sampling >300 women from Jan+Feb. • Sampling by discharge date rather than delivery date. • Excluding births from one of the trust’s sites. • Adding site codes for home births. • Missing or incorrect CCG codes. • Full details available in Sampling Errors Report.

24. Sample declaration form • Excel sheet with a series of checklist items • Comment boxes for trusts to explain N/As • Additional comment box for trusts to explain any changes in sample profile since 2018. • New for 2019: instead of total deliveries, trusts will be asked to enter their number of exclusions (broken down by the reason for exclusion) • Must be electronically signed by the person drawing the sample and the Caldicott Guardian.

25. Sample declaration form • Email to contractor (or Survey Coordination Centre for in-house trusts) before submitting sample file. • Must be sent from email of Caldicott Guardian, or from email of sample drawer with Caldicott Guardian copied in. • Form must be approved before sample file is submitted. • Form will be published on our website following S251 approval being granted

26. Submission of sample files • Sample declaration form must be approved before any files are submitted. • Trusts using a contractor: submit a single file containing both sample and mailing information to contractor’s FTP. They will provide instructions on how to do this. • In-house trusts: submit only the sample data to the Survey Coordination Centre’s FTP. • All trusts must password protect their files. • The Survey Coordination Centre must not receive any mailing data.

27. Deceased checks • It is essential that multiple deceased checks are conducted throughout the survey period. • Includes women AND babies. • Five stages of checks: • Initial trust (local) check prior to submitting sample • DBS check prior to submitting sample • Trust check AND DBS check prior to 1st mailing • Trust check AND DBS check prior to 2nd mailing • Trust check AND DBS check prior to 3rd mailing • Trusts using a contractor: advise your contractor immediately if any women or their babies die after submitting your sample. • In-house trusts: record deaths with the appropriate outcome code in the sample file.

28. Antenatal/postnatal data • Trusts are asked to submit antenatal and postnatal (attribution data). • This information identifies whether each woman in your sample received their antenatal and/or postnatal care from your trust. • Tells us whether we can attribute women’s responses on antenatal and postnatal questions to your trust. • Compiled after sample is drawn, using electronic records (or postcode sector information if electronic records not available). • Enter attribution data into the Attribution Spreadsheet. • Make sure you have the final approved version of your sample file before you start. • Submitted in a separate file directly to the Survey Coordination Centre. • Full details in the Attribution Instructions.

29. Sampling and submission overview (trusts using a contractor) Trust compiles sample of eligible women. Trust conducts internal and DBS checks for deaths of women / babies. Trust removes any deceased. Trust submits sample declaration form to contractor. Contractor checks the form. Once sample declaration form is approved, trust submits a single sample and mailing file to contractor’s FTP. Contractor checks the file and responds to trust with any queries. Contractor creates separate sample and mailing files. Contractor submits declaration form and sample file (not mailing file) to Survey Coordination Centre. Survey Coordination Centre checks sample and sends queries / approval to contractor. Once sample approved by Survey Coordination Centre, contractor sends out mailing packs for trust. Trust submits antenatal and postnatal data directly to Survey Coordination Centre’s FTP.

30. Sampling and submission overview (in-house trusts) Trust compiles sample of eligible women. Trust conducts internal and DBS checks for deaths of women / babies. Trust removes any deceased. Trust creates separate sample and mailing files. Trust submits sample declaration form to Survey Coordination Centre. Survey Coordination Centre checks the form. Once sample declaration form is approved, trust submits sample file only to Survey Coordination Centre’s FTP. Survey Coordination Centre checks sample and sends queries / approval to trust. Once sample approved by Survey Coordination Centre, trust sends out mailing packs. Trust submits antenatal and postnatal data directly to Survey Coordination Centre’s FTP.

31. Tips for entering fieldwork on time • Entering fieldwork on time or early will help your trust to maximise your response rate, especially from younger mothers and minority ethnic groups. • Ensure you have a survey team in place before you start drawing your sample. • Generate your sample promptly – begin preparing now. • Respond to queries as soon as possible to avoid unnecessary delays. • Ensure there is sufficient resourcing around the sample drawing period – communicate with your team, and handover tasks if staff are going to be on leave.

32. Fieldwork monitoring information

33. Fieldwork monitoring information (in-house trusts only) • Due every Thursday from 2nd May – 22nd August. • Template will be provided on website.

34. Key dates

35. Key dates

36. Current status

37. Current status • Section 251 application: • Submitted December 2018 • Meeting: February 2019 • Outcome ETA: early/mid March 2019 • Ethics application: • Submitted: January 2019 • Review: February 2019 • Outcome ETA: early/mid March 2019 • Instruction manuals: • Currently being finalised • Publication ETA (post-S251 approval): early/mid March 2019

38. Questions?

39. Thank you for your time • A copy of these slides will be available on the NHS Surveys website here. • Survey Coordination Centre contact details: • maternity@surveycoordination.com • 01865 208 127